Preparing Graduate Registered Nurses for Independence in Aged Care.

BACKGROUND: Graduate registered nurses (RNs) start their careers working in a variety of clinical areas including aged care. However, they may not be fully prepared to work in aged care settings that often require them to work independently as the only RN on the premises. A list of essential clinical skills is crucial for supporting the development and effective transition of graduate nurses into aged care. AIMS: To identify and rank a list of essential clinical skills for graduate RNs working in aged care settings on commencement of practice. METHODS: An explanatory sequential mixed-methods design was applied and included a modified Delphi Study and semi-structured interviews. Five expert aged care RNs engaged in the three iterative Delphi rounds and five graduate aged care RNs were interviewed to confirm the clinical skills and ranking from their perspective. Quantitative data were presented through descriptive statistics. Qualitative data were analysed using thematic analysis. RESULTS: Thirty-six essential clinical skills for graduate RNs working in aged care settings were identified and ranked by the experienced aged care RNs. Graduate RNs supported this list of essential clinical skills on commencement and identified palliative care as an additional skill required by graduate RNs working in aged care. CONCLUSION: The derived essential skills offer aged care a guided approach to ensure that graduate RNs are work-ready, safe practitioners and supported to work independently. IMPLICATIONS FOR PRACTICE: The study recommends the essential clinical skills for graduate nurses transitioning in their role as RNs in aged care that will support safe, quality clinical care.

Challenges in implementing community-based dental education programs in Australia: The lived experiences of program coordinators.

PURPOSE: The benefits of community-based dental education (CBDE) are well documented and reach far beyond students' educational growth, encompassing advantages for both dental schools and their community partners. Nonetheless, barriers associated with administering CBDE programs can have a significant impact on program outcomes. This study aims to explore the challenges faced by dental school CBDE coordinators in implementing and managing their programs. METHODS: This Interpretive Phenomenological study employed in-depth semi-structured interviews with CBDE program coordinators from Australian dental schools (n = 6). Interviews, conducted between February and May 2023, via Microsoft Teams, were audio and video recorded and lasted an average of one hour each. Interviews were analyzed using NVivo 13. Questions explored administrative challenges, required resources, student management issues, and development goals for CBDE programs. RESULTS: Data analysis included deductive and inductive coding through a seven-step iterative process, organizing information into codes and sub-codes, forming emerging themes. Four major themes with subthemes emerged: 1) Program administration, encompassing challenges in scheduling, coordinating, and adapting to changes; 2) Funding, crucial for establishing and maintaining remote educational sites; 3) Student experience management, highlighting student supervision, student behavior, and exposure; and 4) Partner site relationships, particularly in clinical supervisor recruitment and training. CONCLUSION: The successful implementation requires meticulous planning, effective coordination, and recognition of CBDE as an educational activity that should be grounded in evidence-based pedagogy. Dental institutions are therefore encouraged to establish collaborative partnerships with local community organizations, allocate resources for outreach initiatives, and facilitate appropriate guidance to coordinators, students, and external clinical supervisors.

Student and clinical supervisor perceptions of community-based dental educational experiences: A scoping review.

PURPOSE: This scoping review was conducted to map the breadth of experiences in community-based dental education (CBDE), as reported by students and clinical supervisors. METHODS: This scoping review was conducted following the structured framework proposed by Arksey and O'Malley and adhering to PRISMA-SCR guidelines for scoping reviews. Applying specified eligibility criteria, a systematic search of four electronic databases (PubMed, Scopus, Embase, and Web of Science) was followed by data extraction and data synthesis of full-text articles. Research was conducted between June 2022 and September 2022. RESULTS: Sixteen articles were identified for the final full-text review. Utilizing a narrative thematic review, the following five domains emerged: preparation for autonomous practice, understanding of primary care dentistry, understanding of health disparities and patient needs, clinical confidence, clinical diversity, and skill development, and perspectives on quality of teaching and assessment. CONCLUSION: Community/outreach dental education effectively supplements traditional dental school-based education from the perspectives of students and community-based clinical supervisors.

Educators' consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design.

BACKGROUND: Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators' consideration and application of student motivation in ophthalmology medical education. MATERIAL AND METHODS: Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes. FINDINGS: Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists' confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools. CONCLUSION: There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.

Self-determination theory in ophthalmology education: factors influencing autonomy, competence and relatedness in medical students.

BACKGROUND: The affective components of learning, including student motivation, has yet to be thoroughly investigated in undergraduate ophthalmology education. This study aims to use Self-Determination Theory (SDT) as a framework to describe the variations in student perceptions of motivation in studying ophthalmology through their satisfactions of autonomy, competence and relatedness, and to highlight factors that stimulate or hinder this. METHODS: Penultimate year medical students from a single tertiary educational institution undertaking a clinical placement in ophthalmology participated in in-depth interviews to explore factors affecting their perceptions of motivation in studying ophthalmology. Interviews were transcribed and analysed according to the principles of interpretive phenomenography through the theoretical framework of SDT. RESULTS: Of the 39 students invited, 10 agreed to participate. Variations in perceptions of experiences generated the outcome space. Participants experienced either amotivation, external locus extrinsic motivation, internal locus extrinsic motivation and intrinsic motivation (conceptions of the outcome space). This was described with respect to their satisfaction of autonomy, competence and relatedness (dimensions of the outcome space). Additionally, 21 factors that impacted on motivation were identified, of which five over-arching factors impacted all three basic psychological needs - guidance, growth mindset, assessment, curricular pressure and extracurricular pressure. CONCLUSIONS: The findings of this study provide a unique insight into the motivation of medical students studying ophthalmology. This provides an exciting opportunity for medical educators to address the affective aspect of learning.

Expert consensus on the attributes and competencies required for rural and remote junior physicians to work effectively in isolated indonesian communities.

Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians' ability to be effective in their practice. The essential attributes included professional quality related to prioritising the rural community. The essential competencies included medical skills, professional behaviour, interprofessional skills, health promotion and connection to the rural community. The consensus thus reached on these essential and important attributes and competencies can inform curriculum development for the undergraduate and postgraduate training of junior rural and remote physicians.

Attracting, Recruiting, and Retaining Medical Workforce: A Case Study in a Remote Province of Indonesia.

Indonesia, one of the Asia Pacific low-and middle-income countries (LMICs), has suffered from a chronic medical workforce shortage. However, there are limited published studies describing the approaches implemented by the Indonesian government regarding the recruitment and retention of the medical workforce. This case study aimed to understand the current practices for recruitment and retention of the medical workforce in Indonesian rural and remote provinces. We conducted a case study of the Maluku Province of Indonesia with a document analysis and key informant interviews with officials responsible for medical workforce recruitment and retention. We used the World Health Organization's (WHO) guidelines as an analytical matrix to examine the recruitment and retention practices under the four domains of (i) educational, (ii) regulatory, (iii) financial, and (iv) professional and personal development and classified them into either University/Medical School level or Government/Non-government level. Our findings suggest that Indonesia implemented most of the WHO-recommended medical workforce recruitment and retention strategies. However, implementation is still problematic; hence, the aim of establishing an adequate, sustainable medical workforce has not been reached. Nationwide government intervention in educational aspects is important to magnify the impact of regional medical school initiatives. Relevant programmes must be re-evaluated and re-enforced concerning significance, comprehensiveness, and effectiveness for a sustainable rural and remote medical workforce.

InspirE5: a participatory, internationally informed framework for health humanities curricula in health professions education.

BACKGROUND: Reporting on the effect of health humanities teaching in health professions education courses to facilitate sharing and mutual exchange internationally, and the generation of a more interconnected body of evidence surrounding health humanities curricula is needed. This study asked, what could an internationally informed curriculum and evaluation framework for the implementation of health humanities for health professions education look like? METHODS: The participatory action research approach applied was based on three iterative phases 1. Perspective sharing and collaboration building. 2. Evidence gathering 3. Development of an internationally relevant curriculum and evaluation framework for health humanities. Over 2 years, a series of online meetings, virtual workshops and follow up communications resulted in the production of the curriculum framework. RESULTS: Following the perspective sharing and evidence gathering, the InspirE5 model of curriculum design and evaluation framework for health humanities in health professions education was developed. Five principal foci shaped the design of the framework. ENVIRONMENT: Learning and political environment surrounding the program. Expectations: Graduate capabilities that are clearly articulated for all, integrated into core curricula and relevant to graduate destinations and associated professional standards. EXPERIENCE: Learning and teaching experience that supports learners' achievement of the stated graduate capabilities. EVIDENCE: Assessment of learning (formative and/or summative) with feedback for learners around the development of capabilities. Enhancement: Program evaluation of the students and teachers learning experiences and achievement. In all, 11 Graduate Capabilities for Health Humanities were suggested along with a summary of common core content and guiding principles for assessment of health humanities learning. DISCUSSION: Concern about objectifying, reductive biomedical approaches to health professions education has led to a growing expansion of health humanities teaching and learning around the world. The InspirE5 curriculum and evaluation framework provides a foundation for a standardised approach to describe or compare health humanities education in different contexts and across a range of health professions courses and may be adapted around the world to progress health humanities education.

Commitments, Conditions and Corruption: An Interpretative Phenomenological Analysis of Physician Recruitment and Retention Experiences in Indonesia.

Complex factors influence physicians' decisions to remain in rural and remote (RR) practice. Indonesia, particularly, has various degrees of poor governance contributing to physicians' decisions to stay or leave RR practice. However, there is a paucity of literature exploring the phenomenon from the perspective of Indonesian RR physicians. This study explores physicians' lived experiences working and living in Indonesian RR areas and the motivations that underpin their decisions to remain in the RR settings. An interpretative phenomenological analysis was utilised to explore the experiences of 26 consenting voluntary participants currently working in the RR areas of Maluku Province. A focus group discussion was undertaken with post-interns (n = 7), and semi-structured interviews were undertaken with junior (n = 9) and senior physicians (n = 10) working in district hospitals and RR health centres. Corruption was identified as an overarching theme that was referred to in all of the derived themes. Corruption adversely affected physicians' lives, work and careers and influenced their motivation to remain working in Indonesia's RR districts. Addressing the RR workforce shortage requires political action to reduce corruptive practice in the districts' governance. Establishing a partnership with regional medical schools could assist in implementing evidence-based strategies to improve workforce recruitment, development, and retention of the RR medical workforce.

When the wheels fall off - Medical students' experiences of interrupted academic progression.

INTRODUCTION: There is limited published research on medical students' perspectives of a significant interruption to their academic progression. This study sought to identify the factors that contribute to difficulties with academic progression and to understand how medical students successfully respond. METHODS: This interpretive phenomenological study reports on the findings from in-depth interviews of 38 final year medical students who had experienced a significant academic interruption. RESULTS: The two superordinate themes were: the factors contributing to the interruption and their experience of the interruption. Factors identified as contributing to the interruption were: workload, learning in medicine, motivation for medicine, isolation, adapting to local culture, health and external factors. Their experience of the interruption focused on stages of working through the process: 'what happened,' 'how it felt,' 'managing the failure,' 'accepting the failure' and 'making some changes.' DISCUSSION: Each factor affected how the participants reacted and responded to the interruption. Regardless of the origins of the interruption, most reacted and responded in a comparable process, albeit with varying timespans. These reactions and responses were in a state of fluctuation. In order to succeed many stated they shifted their motivation from external to internal, in direct response to the interruption, resulting in changed learning behaviours. CONCLUSIONS: The process of working through an interruption to academic progression for students may benefit from a model of interval debriefing, restorative academic and personal development support. Facilitation of this process could enable students to face an interruption constructively rather than as an insurmountable emotionally burdensome barrier. Medical schools could utilise these findings to implement further support strategies to reduce the number of significant academic disruptions.

Measuring impostor phenomenon in healthcare simulation educators: a validation of the clance impostor phenomenon scale and leary impostorism scale.

BACKGROUND: Impostor phenomenon is a term used to describe feelings of intellectual and professional fraudulence. The Clance Impostor Phenomenon Scale and the Leary Impostorism Scale are two self-report measures used to determine whether an individual experiences impostor phenomenon. This study examined the psychometric properties of both measures in healthcare simulation educators. METHODS: The study sample comprised 148 educators, 114 (77%) females, 34 (23%) males, who completed an online version of each instrument. Exploratory factor analysis was used to examine the factor structure of the Clance Impostor Phenomenon Scale and the Leary Impostorism Scale. RESULTS: Exploratory factor analysis revealed that for both instruments a one-factor solution best fit the data, suggesting all items in both measures fit onto a single theoretical construct. Both instruments demonstrated high internal reliability, with the Cronbach's alpha for the Clance Impostor Phenomenon Scale being α = .96 and the Leary Impostorism Scale α = .95. CONCLUSIONS: This study suggests that impostor phenomenon as measured by the Clance Impostor Phenomenon Scale and the Leary Impostorism Scale is a unidimensional construct among healthcare simulation educators. With a growing interest in impostor phenomenon, the present findings will assist researchers to evaluate the phenomenon in healthcare settings.

Technology enhanced neuroanatomy teaching techniques: A focused BEME systematic review of current evidence: BEME Guide No. 75.

BACKGROUND: In response to growing curriculum pressures and reduced time dedicated to teaching anatomy, research has been conducted into developing innovative teaching techniques. This raises important questions for neuroanatomy education regarding which teaching techniques are most beneficial for knowledge acquisition and long-term retention, and how they are best implemented. This focused systematic review aims to provide a review of technology-enhanced teaching methods available to neuroanatomy educators, particularly in knowledge acquisition and long-term retention, compared to traditional didactic techniques, and proposes reasons for why they work in some contexts. METHODS: Electronic databases were searched from January 2015 to June 2020 with keywords that included combinations of 'neuroanatomy,' 'technology,' 'teaching,' and 'effectiveness' combined with Boolean phrases 'AND' and 'OR.' The contexts and outcomes for all studies were summarised while coding, and theories for why particular interventions worked were discussed. RESULTS: There were 4287 articles identified for screening, with 13 studies included for final analysis. There were four technologies of interest: stereoscopic views of videos, stereoscopic views of images, augmented reality (AR), and virtual reality (VR). No recommendation for a particular teaching method was made in six studies (46%) while recommendations (from weak to moderate) were made in seven studies (54%). There was weak to moderate evidence for the efficacy of stereoscopic images and AR, and no difference in the use of stereoscopic videos or VR compared to controls. CONCLUSIONS: To date, technology-enhanced teaching is not inferior to teaching by conventional didactic methods. There are promising results for these methods in complex spatial anatomy and reducing cognitive load. Possible reasons for why interventions worked were described including students' engagement with the object, cognitive load theory, complex spatial relationships, and the technology learning curve. Future research may build on the theorised explanations proposed here and develop and test innovative technologies that build on prior research.

Twelve tips for medical students experiencing an interruption in their academic progress.

For every commencing cohort of medical students, a small but significant number will experience an interruption to their academic progression because of academic difficulties, health concerns or external influences outside of the students' control. During the process of researching the factors surrounding difficulties with academic progression, students told us many ways that they have learned from that experience, which then allowed most of them to graduate. This paper combines the shared experiences of students who have had an interruption, and those of the authors as medical educators.

Health Humanities curriculum and evaluation in health professions education: a scoping review.

BACKGROUND: The articulation of learning goals, processes and outcomes related to health humanities teaching currently lacks comparability of curricula and outcomes, and requires synthesis to provide a basis for developing a curriculum and evaluation framework for health humanities teaching and learning. This scoping review sought to answer how and why the health humanities are used in health professions education. It also sought to explore how health humanities curricula are evaluated and whether the programme evaluation aligns with the desired learning outcomes. METHODS: A focused scoping review of qualitative and mixed-methods studies that included the influence of integrated health humanities curricula in pre-registration health professions education with programme evaluate of outcomes was completed. Studies of students not enrolled in a pre-registration course, with only ad-hoc health humanities learning experiences that were not assessed or evaluated were excluded. Four databases were searched (CINAHL), (ERIC), PubMed, and Medline. RESULTS: The search over a 5 year period, identified 8621 publications. Title and abstract screening, followed by full-text screening, resulted in 24 articles selected for inclusion. Learning outcomes, learning activities and evaluation data were extracted from each included publication. DISCUSSION: Reported health humanities curricula focused on developing students' capacity for perspective, reflexivity, self- reflection and person-centred approaches to communication. However, the learning outcomes were not consistently described, identifying a limited capacity to compare health humanities curricula across programmes. A set of clearly stated generic capabilities or outcomes from learning in health humanities would be a helpful next step for benchmarking, clarification and comparison of evaluation strategy.

Neuroanatomy Teaching in Australian and New Zealand Medical Schools.

BACKGROUND: Graduate doctors' knowledge of central and peripheral nervous system anatomy is below an acceptable level. New technologies have been introduced to enhance education in the context of integrated curricula and reduced anatomy teaching hours in medical schools. However, it is unknown how varied this instruction has become between universities. This mixed methods study aimed to describe neuroanatomy teaching in medicine across Australia and New Zealand. METHODS: An electronic survey was sent to Australian (n = 22) and New Zealand (n = 2) medical schools, endorsed by the Royal Australasian College of Surgeons. Academics were asked to comment on the course, content, instruction, and assessment of neuroanatomy for the 2019 academic year. RESULTS: Ninety-two percent (22/24) of medical schools responded. Neuroanatomy content and instructional methodology was highly variable between institutions. The average time dedicated to teaching neuroanatomy was 46.0 hours (±38.1) with a range of 12-160 hours. Prosections (77%) and models (77%) were used at most universities. Dissection was utilized at 13 of 22 (59%) universities. Incorporation of new technologies was highly variable, the most common being 3-dimensional software (59%) and eBook (55%). Adoption of any virtual reality technologies was low (36%). Seven universities used an established curriculum (29%), whereas most did not (61%). Academics indicated anxiety and motivation were key elements of student engagement. CONCLUSIONS: Results demonstrate widespread heterogeneity in the way neuroanatomy is taught to medical students. A standardized curriculum may improve collaboration between universities and facilitate translation of future research in the area into practice.

Relative progress and academic performance of graduate vs undergraduate entrants to an Australian medical school.

BACKGROUND: Whether graduate entrants to medical school perform better academically than undergraduate entrants remains controversial. Differences in the discipline backgrounds of graduates may, at least in part, have accounted for differences in the results of comparative studies reported to date. This study aimed to address the dual issues of whether academic performance and progression rates were different between GE and UG students and the extent to which the discipline background of GE students may underpin any differences observed. METHODS: Relative academic performance as well as indicators of student progression (supplementary examinations, repeat years, leave of absence, withdrawal from the programme) were compared between graduate entrants (GE) (N = 410) and both school leaver entrants (SLE) (N = 865) and non-standard entrants (some prior tertiary education) (NSE) (N = 148) who combined for the final 4 yr. of a 6 yr. MBBS undergraduate programme in 8 consecutive cohorts from 2006 to 2013 in Western Australia. RESULTS: Examination scores were generally at or very close to a distinction grade or higher across all groups. Higher mean examination scores were seen for GE versus both SLE and NSE in the first 2 years with no significant differences in the final 2 years. GE from biological science / science backgrounds (N = 241) or physical science backgrounds (N = 26) performed the same as SLE and NSE throughout the programme. GE with a health / allied health background (N = 91), however, performed better throughout. They also performed better when compared to their GE counterparts from a humanities (N = 32) or a biological science / science background. GE had increased odds of withdrawing when compared to SLE (OR 2.50, 95% CI 1.30, 4.79, P = 0.006), but not compared to NSE. NSE had increased odds of repeating at least one level when compared to either GE (OR 2.74, 95% CI 1.21, 6.21, P = 0.016) or SLE (OR 4.10, 95% CI 1.93, 8.70, P < 0.001). There were no differences by entry category in the odds of sitting at least one supplementary examination during the programme. There was an increase in the odds of taking at least one leave of absence in both SLE (OR 2.55, 95% CI 1.79, 3.63, P < 0.001) and NSE (OR 2.47, 95% CI 1.50, 4.07, P < 0.001) compared to GE. CONCLUSIONS: Better academic performance by GE compared to SLE and NSE was predominantly due to higher scores for GE with a health / allied health background. GE were also less likely to have impeded progress during the course.

Student motivation to learn: is self-belief the key to transition and first year performance in an undergraduate health professions program?

BACKGROUND: Student motivation to learn has been undervalued to date though has been identified as an area influencing student success and retention at university. The transition into university has been highlighted as a key period affecting student outcomes as well as well-being. Early identification of those students at risk may assist the transition for many students moving into higher education. Previous research has identified the Motivation and Engagement Scale - University/College (MES-UC) as a valid instrument for measuring motivation to learn in physiotherapy students. The aim of this study was to determine the relationship between a student's motivation to learn on entry into an undergraduate physiotherapy program and their performance through first year. The relationship of admissions scores, to motivation to learn on entry, were also considered, to determine any link between these measures. METHODS: An observational longitudinal study was conducted on one cohort of undergraduate physiotherapy students commencing their studies in 2015 with a response rate of 67%. Correlations were performed between admission variables and Year 1 MES-UC scoring; and between Year 1 MES-UC scoring and subsequent academic performance across first year, taking into consideration gender and age. RESULTS: Self-belief was identified as the key dimension of motivation influencing student success in the transition into university. Results identified the link between self-belief scores on entry and academic performance in first year, including grade point average and performance in six of nine courses. Courses where there was no significant relationship were identified as curriculum areas where students may be less motivated. There was a relationship between the admissions interview and MES-UC scoring, demonstrating a link between non-cognitive selection measures and student motivation to learn on entry into the program. CONCLUSION: Motivation to learn and specifically self-belief with learning, may be influential in the transition into higher education. Undertaking measures of academic motivation may be useful to determine student engagement with curriculum, through identifying any link between student self-belief and performance in specific courses. Changes to curriculum based on student motivation as well as targeting early those students with reduced self-belief may improve student success, psychosocial wellbeing and retention.

Likelihood of rural practice in medical school entrants with prior tertiary experience.

Background: Workforce decisions of medical students with prior tertiary education, relative to those without, are not known. Methods: Rural workforce outcomes for three separate streams of medical students were compared: school leaver entry (SLE) entered medical school direct (N = 682), non-standard entry (NSE) had some prior tertiary education (N = 123), and graduate entry (GE) (N = 317), had a prior completed degree. All students were at least in postgraduate year 3 in 2018, when current urban or rural medical workforce participation was ascertained. Results: Multivariate logistic regression allowing for the influences of rural background, rural clinical school participation, gender, being born overseas, socioeconomic status, and being a bonded rural scholar, showed that NSE students and GE students had increased odds of being in rural practice relative to SLE students. This increase was more than three-fold for NSE students (OR = 3.41, 95% CI 1.94, 5.99, p < 0.001) and greater than two-fold for GE students (OR = 2.54, 95% CI 1.57, 4.10, p < 0.001). Conclusion: Graduates with prior tertiary education were more likely to enter the rural medical workforce than direct school entrants. This suggests that increasing graduate entry programs may augment the rural medical workforce and that undergraduate programs allowing non-standard entry may have the same benefit.

What are the attributes of excellence in an acute practice occupational therapist?

BACKGROUND/AIM: There is anecdotal recognition within the profession that novice occupational therapists who perform well at interview do not necessarily make the best practising clinicians. Further anecdotal evidence suggests that it is difficult to tell (at interview) which occupational therapists will follow which path and whether further training can achieve excellence in existing staff. What is it that makes the difference? What attributes do those truly 'excellent' clinicians have that makes them better than others? METHOD: A two-round Delphi survey was utilised and 18 expert occupational therapists were purposively recruited from Perth's three adult tertiary hospitals. Panellists rated and ranked sixteen possible attributes that could comprise excellence in an acute practice occupational therapist. RESULTS: The final order of importance (from most to least) of the 16 possible attributes of excellence was determined. Communication, Self-management and Critical Thinking were found to be the three most important attributes, whereas Humility was considered the least important attribute. All attribute rankings achieved at least a low level of consensus. CONCLUSION: We now have a much clearer picture of what excellence looks like in the acute practice setting, giving managers a new understanding. There is now the possibility of integrating this information into both the recruitment of new staff and the professional development of existing staff. In this way we can move forward to a future that includes the active development of occupational therapy excellence in ways that were not possible before these results were available.

Predicting performance of junior doctors: Association of workplace based assessment with demographic characteristics, emotional intelligence, selection scores, and undergraduate academic performance.

INTRODUCTION: Predicting workplace performance of junior doctors from before entry or during medical school is difficult and has limited available evidence. This study explored the association between selected predictor variables and workplace based performance in junior doctors during their first postgraduate year. METHODS: Two cohorts of medical students (n = 200) from one university in Western Australia participated in the longitudinal study. Pearson correlation coefficients and multivariate analyses utilizing linear regression were used to assess the relationships between performance on the Junior Doctor Assessment Tool (JDAT) and its sub-components with demographic characteristics, selection scores for medical school entry, emotional intelligence, and undergraduate academic performance. RESULTS: Grade Point Average (GPA) at the completion of undergraduate studies had the most significant association with better performance on the overall JDAT and each subscale. Increased age was a negative predictor for junior doctor performance on the Clinical management subscale and understanding emotion was a predictor for the JDAT Communication subscale. Secondary school performance measured by Tertiary Entry Rank on entry to medical school score predicted GPA but not junior doctor performance. DISCUSSION: The GPA as a composite measure of ability and performance in medical school is associated with junior doctor assessment scores. Using this variable to identify students at risk of difficulty could assist planning for appropriate supervision, support, and training for medical graduates transitioning to the workplace.